Page 5 - Cover Letter and Medicare Evaluation for Rod Morgan

financial incentive to score well because every year that they are rated four stars or higher,
they are awarded substantial bonuses.

As you know, in an Advantage PPO plan you will be covered when you see an out-of-network
provider, but the costs will be higher and will also count toward a higher out-of-pocket limit
than the limit which applies only to network services.

Moreover, some PPO plans may consider referrals made by an out-of-network doctor as out-of-
network costs. As an example, if a non-network doctor refers you for a lab test, then the test
may be considered as an out-of-network cost even if it’s provided by a laboratory that’s in the
network. While that’s not the case with most PPO plans, it’s something you may want to check
before enrolling. And of course, verify that Dr. Dunn is in the plan’s network.

Below are summaries of the two Advantage PPO plans compared in your evaluation, and their
benefit summaries are in the appendices. In addition to high quality ratings, both plans have no
premiums and no deductibles for health or Rx drug coverage. And both plans include dental
benefits, some worldwide coverage for medical emergencies, and health club memberships.

1) Anthem MediBlue Access Advantage PPO Plan. This four-star plan has the lowest costs
for your Rx drugs of any option. Also, its costs for a hospitalization are less than most
other Advantage plans ($325 a day for the first five days in a network hospital). This
plan’s $6,700 out-of-pocket limit for network services is high, and that limit increases to
$10,000 when out-of-network costs are included.

There are no co-pays for doctor’s office visits to your primary care physician, and $35
co-pays to see a specialist. If you see a doctor who is not in the Anthem network, you’ll
have a $35 co-payment for a primary care visit and a $70 co-payment for a visit to a
specialist. Dental, vision, and hearing benefits appear to be good, but before enrolling in
this plan you might want to verify that your dentist and optometrist will accept this
coverage. Anthem also sells supplemental dental/vision packages for monthly
premiums of $7, $29, and $56, respectively. The benefit summary is in Appendix D2.

2) Aetna Medicare Prime 1 Advantage PPO Plan. This 4.5-star rated plan has several good
features, including a much lower ($5,300) in-network out-of-pocket limit for medical
services. Its hospitalization costs are moderately higher than those of the Anthem plan,
but it appears to have stronger dental, vision, and hearing benefits than the Anthem
plan’s, although there’s not enough detail in the plan’s benefit summary to be certain.

In this plan if you go an out-of-network doctor, you will pay a steep 40% of the cost
(except in emergencies). And the out-of-network spending limit is $11,300, which is the
highest Medicare allows. In-network doctor’s office visit co-pays are the same as in the
Anthem plan – no cost to see a primary care physician and $35 to see a specialist. This
plan’s benefit summary is in Appendix D3.

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